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HOSPITAL  CONSTRUCTION, 


BY 


EDWARD  HUTCHINSON,  M.  D. 


To  the  State  Board  of  Charities : 

Gentlemen  —  The  subject  of  hospital  construction  has  engaged 
the  attention  of  philanthropists  for  years,  but  never,  perhaps,  with 
more  earnestness  than  at  the  present  time.  The  statistics  of  the 
old  time  hospitals  of  the  larger  cities  on  the  continent  have  given 
such  alarming  death  rates  from  diseases  not  frequently  met  with  in 
private  practice,  that  every  exertion  has  been  made  to  ascertain 
what  have  been  the  causes  of  the  mortality. 

No  one  has  done  more  to  show  the  evil  results  of  over-crowding 
as  affecting  the  surgical  cases,  and  to  call  attention  to  the  saving  of 
life  which  could  and  should  be  made  by  those  having  under  their 
control  the  construction  of  establishments  for  the  sick,  than  Sir 
James  Y.  Simpson,  of  noble  memory.  Miss  Florence  Nightingale 
has  spent  her  life  investigating  the  causes  of  the  excessive  mortality 
in  great  hospitals,  and  has  written  most  ably  in  behalf  of  enlight¬ 
ened  management  in  the  conduct  of  these  institutions.  Sanita¬ 
rians  everywhere  have  made  a  study  of  the  means  best  adapted  to 
insure  the  welfare  of  invalids,  and  to  give  them  the  best  chances  for 
recovery.  All  are  agreed  that  solid  hospitals  of  two,  three  and 
four  stories,  with  their  layers  of  sick,  are  bad,  and  some  have  even 
questioned  whether  it  would  not  be  better  to  keep  invalids  at  home 
even  with  all  the  inconvenience  and  hardship  to  result  from  such  a 
course,  than  to  invite  death  by  exposing  them  to  the  dangers  of 
hospitalism. 

Under  the  wise  administration  of  the  Army  Medical  Bureau 
during  our  late  war,  the  fact  was  soon  ascertained  that  both  sick  and 
wounded  men  recovered  sooner  in  tents,  and  with  less  average  mor¬ 
tality,  than  in  old-fashioned  hospitals.  When  it  became  necessary 
to  construct  large  permanent  hospitals  in  the  rear,  the  tent  or 
pavilion  plan  was  the  one  adopted.  This  showed  great  wisdom, 
and  the  saving  of  life  in  consequence  was  immense.  The  Germans 
were  quick  to  take  advantage  of  the  experience  we  had  to  offer,  and 
built  pavilion  hospitals  for  the  wounded  of  both  sides,  in  the  war  of 
1866,  and  also  in  the  late  war  of  1871.  By  having  the  wounded 
and  sick  in  open  tents  or  light  wrnoden  structures,  located  in  airy 
positions  wTith  plenty  of  sunshine  and  ventilation,  the  results  were 
surprising.  Erysipelas  and  pyaemia  with  hospital  gangrene  became 
rare,  and  when  these  dreadful  diseases  did  break  out,  the  infection 
was  less  apt  to  spread.  In  the  southern  states  too,  the  confederates 


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did  not  fail  to  see  the  advantages  of  this  method,  and  in  Atlanta,. 
Ga.,  and  Raleigh,  1ST.  C.,  their  admirable  pavilions  were  models  of 
neatness  and  convenience.  In  Dresden,  Leipzig,  Ghent  and  Berlin 
there  are  fine  one  storied  pavilion  hospitals;  but  in  this  country,  so 
far  as  I  am  aware,  there  has  been  no  considerable  attempt  to  make 
them  permanent. 

The  objects  of  a  good  hospital  maybe  briefly  described:  —  To 
care  for  the  sick  better  than  they  can  be  provided  for  in  their  own 
homes :  to  cure  sick  people  at  the  least  expense :  to  have  a  conven¬ 
ient  administration  so  that  a  few  physicians  and  nurses  can  do  the 
Aork :  to  give  those  suffering  from  surgical  operations  the  best 
chances  for  recovery  with  life  and  limb  :  to  care  for  the  poor  who 
cannot  afford  the  things  necessary  for  their  own  comfort :  that  child¬ 
bed  cases  may  be  kept  secluded  and  not  exposed  to  dangerous  influ¬ 
ences  by  contagion,  whether  by  physician,  nurses  or  location :  to 
have  provision  for  the  contagious  diseases  of  childhood  as  well  as  for 
those  of  adult  life,  so  that  the  mortality  may  not  be  increased  by  the 
aggregation  of  the  sick. 

In  regard  to  the  general  construction  of  a  hospital,  the  following 
points  may  help  to  guide  us. 

Arrange  the  wards  so  that  no  sick  person  will  endanger  the  life 
of  another. 

Have  a  plentiful  supply  of  pure  air,  with  provision  for  the  escape 
of  the  foul  air. 

Supply  at  least  1,200  cubic  feet  of  air  to  each  bed. 

Separate  the  sexes,  and  also  medical,  surgical  and  child-bed  cases. 

Make  provision  for  isolating  contagious  diseases. 

Have  a  bountiful  supply  of  pure  water. 

Have  all  the  drains  go  entirely  outside  of  the  buildings. 

The  wards  should  be  so  arranged,  that  they  may  have  the  greatest 
possible  exposure  to  the  sun. 

Separate  the  convalescents  from  those  confined  to  bed  —  during 
the  day  at  least. 

Have  the  wards  on  one  floor,  and  but  one  story  high. 

Delirium  tremens,  accident  and  insane  patients  should  have  apart¬ 
ments  at  such  a  distance  from  the  wards  that  they  may  not  disturb 
the  rest  of  the  sick. 

There  should  be  small  wards  to  isolate  troublesome  patients,  and 
for  those  who  are  easily  disturbed. 

The  kitchen  and  laundry  should  be  separate  from  the  wards,  so 
that  the  odors  of  washing  and  cooking  cannot  reach  the  sick. 


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Water-closets  and  slop-sinks  should  be  away  from  the  wards, 
and  have  separate  ventilation. 

The  nurses’  room  should  overlook  the  ward. 

There  should  also  be  a  high  and  airy  situation  ;  a  cheerful  view  ; 
in-door  promenades ;  extensive  ground  for  exercise  ;  flower  gardens 
and  lawn. 

Have  no  cellars  under  the  wards. 

Have  hard,  unabsorbing  surfaces  for  walls  and  ceilings. 

Let  the  floors  be  oiled  or  painted,  so  that  they  will  not  absorb 
water. 

The  wards  should  be  so  far  distant  from  each  other  that  the  air 
may  circulate  freely. 

The  corridors  connecting  the  wards  to  be  open  beneath,  and  pro¬ 
vided  with  glass  windows  to  slide  open,  to  allow  the  air  to  blow 
under  and  through  them. 

Have  fire-places  in  the  wards  to  assist  ventilation,  and  to  supple¬ 
ment  the  heating  apparatus. 

Have  two  steam  boilers  for  fear  of  accident. 

The  administration  building  ought  to  be  distinct  from,  yet  attached 
to,  the  wards. 

The  heating,  washing,  drying  and  cooking  should  be  done  by 
steam. 

Have  such  an  arrangement  of  the  wards  that  any  one  of  them  can 
be  disinfected,  or  even  torn  down,  without  disturbing  the  general 
administration. 

The  trustees  of  St.  Elizabeth’s  Hospital,  Utica,  in  order  to  accom¬ 
modate  the  increasing  number  of  patients  who  apply  for  admission, 
have  had  under  consideration,  for  a  long  time,  plans  for  a  new 
hospital.  These  are  now  submitted  for  your  suggestions,  with  the 
hope  that  whatever  is  good  in  them  may  be  of  service  to  others,  and 
that  you  will  point  out  any  defects  or  omissions,  in  order  that  they 
may  be  corrected.  The  architect,  Mr.  Wm.  H.  Hamilton,  of  Utica, 
is  deserving  of  the  highest  praise  for  his  intelligent  aid  and  valuable 
labors.  To  him  the  trustees  desire  to  express  their  thanks,  and 
also  to  acknowledge  their  obligation  to  Dr.  John  P.  Gray,  of  the 
State  Lunatic  Asylum,  for  having  interested  himself  from  the  first 
in  perfecting  the  present  plan  of  construction,  and  for  his  many 
suggestions  and  final  approval. 

The  hospital  will  be  built  on  the  pavilion  plan,  on  high  ground, 
situated  in  the  eastern  part  of  the  city.  Its  general  appearance  is 
shown  by  the  engraving  at  the  beginning  of  this  article.  The  cen¬ 
tral  building  is  designed  to  contain  the  rooms  for  general  adminis- 
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tration,  dispensary,  parlors,  office,  library,  operating-room,  and 
apartments  for  the  religions  order  which  has  control  of  the  institu¬ 
tion.  In  the  basement  will  be  the  porter’s  room,  and  the  small 
wards  for  delirium  tremens  and  insane  patients,  and  accident  cases. 

The  pavilions  are  arranged  on  each  side  of  the  main  building,  as 
shown  in  the  second  engraving,  and  radiate  from  the  circumference 
of  a  circle,  in  such  a  manner  that  the  end  wards  will  be  on  a  line 
with  the  principal  structure. 

They  will  be  at  least  thirty  feet  apart  in  front,  where  they  are 
nearest  together,  and  sixty  feet  apart  in  the  rear.  This  will  allow 
of  a  free  circulation  of  air,  will  not  obstruct  the  light,  and  will  be 
sufficient  to  prevent  the  spreading  of  contagious  diseases  if  any 
should,  by  accident,  be  received.  They  will  be  connected  with  each 
other  and  with  the  administration  building  by  glass  corridors  twelve 
feet  wide  and  ten  feet  high.  These  are  entirely  open  "beneath,  and 
have  flat  roofs  which  are  guarded,  front  and  rear,  by  railings  to  pro¬ 
tect  those  who  wish  to  sit  in  the  open  air.  The  fronts  of  the 
pavilions  have  large  bay  windows  in  order  that  the  convalescents 
may  enjoy  the  lovely  view  of  the  Deerfield  hills  ahd  Mohawk  val¬ 
ley.  The  front  of  each  pavilion  will  be  two  stories  high  and  may 
be  called  the  administration  end.  This  will  contain,  on  the  first 
floor,  the  extra  diet  kitchen,  dining  room  for  convalescents,  the 
linen  room,  the  trunk  room  for  patients’  clothing,  a  nurses’  room 
overlooking  the  ward,  and  bath  rooms  and  water  closets.  In  front 
is  a  large  hall  for  exercise  and  recreation.  Up  stairs,  are  rooms  for 
reading,  sewing  and  amusement.  It  is  intended  that  patients  who 
are  able  to  leave  the  wards  during  the  day  shall  pass  most  of  their 
time  here,  and  not  in  the  wards.  The  third  engraving  will  give  an 
accurate  idea  of  the  first  floor  of  a  ward  pavilion. 

Back  of  the  administration  end  is  the  ward  proper.  This  is  one 
story  high  and  intended  to  contain  20  beds.  It  is  80  feet  long,  26 
feet  wide  and  16  feet  high,  giving  33,280  cubic  feet  in  all,  or  1,661 
cubic  feet  of  air  for  each  patient,  and  101  square  feet  for  each  bed. 
The  southern  end  of  the  ward  will  be  inclosed  with  glass,  like  a 
conservatory,  so  that  the  sick  may  have  the  benefit  of  sun  baths, 
and  it  may,  if  desirable,  be  ornamented  with  flowers. 

The  windows  reach  from  floor  to  ceiling,  and  are  so  arranged  as 
to  have  two  beds  between  them.  The  sunlight  will  be  admitted 
freely. 

The  floors  will  be  made  of  narrow  hard  wrood  boards,  driven 
together  and  made  water  tight.  The  wralls  and  ceilings  will  be  hard 
finished  and  painted  with  a  silicate  of  soda  composition,  so  that  they 


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259 


may  be  washed.  This  will  allow  the  whole  surface  to  he  easily 
cleaned. 

It  will  be  observed  that  the  projecting  portion  of  the  pavilion 
inclosing  the  water  closets  has  a  separate  tower  reaching  above  the 
roof,  for  ventilation.  This  tower  can  be  removed  still  further  from 
the  hall  and  made  external  to  the  outer  wall,  but  wherever  it  is,  it 
will  be  difficult  to  prevent  the  odors  from  escaping  into  the  build¬ 
ing.  A  constant  flow  of  water  and  daily  washing  are  the  best 
means  to  keep  this  department  in  good  sanitary  condition. 

The  pavilions  will  be  constructed  of  wood  with  double  walls,  and 
the  roofs  will  be  covered  with  slate.  The  basement  walls  will  be 
arched  in  such  a  manner  that  while  the  air  will  not  be  confined 
underneath  in  warm  weather,  they  may  be  boarded  up,  if  neces¬ 
sary,  in  winter. 

It  will  be  noticed  that  if  it  ever  should  be  desirable,  any  pavilion 
can  be  torn  down  and  rebuilt  without  interfering  with  the  useful¬ 
ness  of  the  hospital,  and  any  one  could  be  disinfected,  or  remain 
unoccupied  any  length  of  time,  without  the  slightest  inconvenience. 

Tlie  buildings  at  each  end  are  two  stories  high  and  divided  into 
double  rooms.  These  are  intended  for  private  patients,  or  for 
those  who  require  seclusion,  such  as  eye  cases,  etc. 

There  is  a  promenade  through  the  front  halls  of  the  pavilions 
and  the  corridors,  nearly  200  feet  long,  on  each  side  of  the  center 
building.  On  the  main  floor  this  is  under  cover,  and  above,  on  top 
of  the  corridors,  the  patients  may  sit  in  the  open  air  in  pleasant 
weather. 

The  kitchen,  laundry,  engine  and  coal  rooms,  with  the  servants’ 
quarters,  will  be  in  a  pavilion  in  the  rear  of  the  main  building. 
The  odor  of  the  cooking  and  washing  cannot  reach  the  sick. 

The  drains  will  all  be  outside  of,  and  not  run  underneath,  any  of 
the  buildings. 

The  engine-room,  in  the  rear,  will  contain  the  steam-boilers,  and 
from  them  the  pipes  will  lead  right  and  left  to  the  pavilions  through 
the  corridors.  In  the  center  there  will  be  two  stacks,  or  coils,  which 
will  warm  the  fresh  air  as  it  comes  through  the  air-boxes  from  out¬ 
side,  as  shown  in  the  fourth  engraving.  These  air-boxes  are  placed 
under  the  floors,  and  open  on  each  side  of  the  ward.  Valves  will 
be  so  arranged  that  the  supply  may  be  regulated  at  pleasure.  This 
will  be  supplemented  by  suitably  arranged  pipes  or  coils  so  placed 
as  to  give  direct  radiation.  The  heating  will  thus  be  by  indirect  or 
direct  radiation,  either  one  or  both,  according  to  the  severity  of  the 
weather.  The  stacks  of  steam-pipes  in  the  center  of  each  ward  will 


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be  so  large,  that  except  in  the  coldest  weather,  they  will  be  expected 
to  heat  enough  fresh  air  to  keep  a  large  and  constant  supply  con¬ 
tinually  in  circulation. 

The  method  of  ventilation  may  be  understood  by  referring  to  the 
fourth  engraving.  The  fresh  air  will  enter  through  the  floors  of 
the  wards  from  the  air-boxes  beneath,  and  after  being  heated  by  the 
large  coils  will  ascend  to  the  ceiling.  The  ventilating  flues,  shown 
at  each  side  of  the  w^ard,  are  to  be  of  glazed  tile,  and  they  will  rise 
from  floor  to  ceiling  near  the  walls,  but  not  be  in  contact  with  them- 
The  foul  air  will  enter  at  the  floor  and  pass  through  the  warmed 
tile-pipes  to  the  attic,  and  thence  out  through  the  escape-flues  in  the 
roof.  These  outside  ventilators  will  be  of  the  same  height  in  all  the 
pavilions,  so  there  can  be  no  downward  currents.  There  will  be 
ten  columns  in  each  ward,  one  between  every  two  beds. 

In  the  present  hospital,  this  system  of  fresli-air  supply,  steam  coil 
heaters,  inside  warm,  ventilating-flues,  with  openings  at  the  floor, 
and  ridge  escape-ventilators  in  the  roof,  is  in  full  and  perfect  opera¬ 
tion.  Practically,  the  air  is  constantly  changing  in  every  ward,  foul 
and  hospital  odors  cannot  be  detected,  and  the  atmosphere  is  far 
purer  than  in  most  private  residences. 

Provision  is  made  for  summer  ventilation,  in  the  new  hospital, 
by  opening  large  circular  ventilators  in  each  ceiling,  and,  with  open 
wundows,  there  will  be  a  constant  change  of  air. 

Double  tire  places  will  be  provided  in  case  any  temporary  accident 
should  befall  the  steam  apparatus. 

Speaking-tubes  will  connect  each  department  with  the  central 
office. 

The  water  supply  will  be  independent. 

The  lying-in  ward  will  have  a  portion  set  aside  by  partition,  as 
shown  in  the  third  engraving,  hfo.  6,  for  a  delivery  wrard.  Should 
child-bed  fever  occur,  the  other  patients  could  be  easily  moved  into 
another  pavilion. 

Children  attacked  with  contagious  diseases  may  be  best  cared 
for  in  some  of  the  upper  rooms,  away  from  the  lying-in  ward. 

A  small  cottage  will  be  built  in  one  corner  of  the  grounds  for  any 
contagious  disease  requiring  complete  isolation. 

Thorough  cleanliness,  abundance  of  sunlight  and  fresh  air,  and, 
if  necessary,  isolation,  will  render  it  difficult  for  any  disease  to 
spread  from  one  patient  to  another. 

The  whole  hospital  will  face  toward  the  north,  where  the  view  is 
exceedingly  beautiful.  The  rear  wards  spread  toward  the  south, 
and  thus  will  be  exposed  to  the  sun  all  the  day  long. 


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Wire  or  gauze  screens  will  be  placed  inside  of  the  windows  so 
that  while  patients  may  look  out,  they  cannot  see  the  sick  in  the 
neighboring  wards- 

The  vegetables  will  be  kept  in  the  outbuildings  and  not  under  the 
wards. 

The  dead  house  and  burial  chapel  will  be  in  the  rear. 

The  great  chimney  will  have  an  iron  smoke  pipe  in  its  center 
reaching  to  the  top.  Around  this  pipe  a  column  of  warm  air  will 
be  constantly  ascending,  and  into  this  space  will  be  conveyed  the 
ventilating  flues  from  the  wash  house,  soiled-linen  room  and  kitchen. 

To  prevent  the  sewage  gases  from  entering  the  buildings,  there 
will  be  a  small  ventilation  pipe  from  each  drain  outside  the  walls, 
reaching  up  above  the  roofs.  This  will  give  an  outlet  for  the  back¬ 
ward  currents  of  sewer  gas,  so  that  the  water  valves  in  the  traps 
may  be  effectual. 

One  objection  that  might  be  suggested  to  the  pavilion  hospital 
just  described,  is  that  it  occupies  too  much  ground.  To  this  it  may 
be  replied  that  it  is  far  better  for  the  sick  to  be  away  from  the  cen¬ 
ter  of  a  town  ;  and  on  th6  outskirts  of  most  cities,  land  may  be  easily 
secured  without  great  expense. 

Whether  the  pavilions  are  far  enough  apart  might  be  a  question  ; 
however,  by  this  arrangement,  the  sick  will  be  separated  from  forty 
to  sixty  feet  across  the  open  spaces,  and  between  the  nearest  beds 
at  least  ninety  feet  wrill  intervene  through  the  halls  and  corridor. 

In  Captain  Galton’s  model  wTard,  in  the  great  Herbert  hospital 
at  Woolwich,  and  in  many  of  the  latest  English  hospitals,  the 
water  closets  and  baths  are  at  the  free  ends  of  the  wards.  This 
arrangement  has  its  advantages,  but  it  cuts  off'  the  sunlight.  In 
the  plan  under  consideration,  the  ends  of  the  wards  project  to  the 
south  and  are  inclosed  with  glass.  The  closets  are  toward  the 
corridors  but  have  distinct  ventilation  and  are  besides  cut  off  from 
direct  communication  with  the  sick  as  completely  as  in  the  English 
method. 

It  has  been  strongly  urged  by  Florence  Nightingale  that  there 
should  be  no  rooms  for  convalescent  patients  to  sit  in  during  the 
day,  as  they  are  apt  to  become  unruly.  To  this  it  may  be  urged,  that 
it  is  better  to  keep  invalids  in  the  hospital  and  under  treatment,  than 
to  allow  them  to  be  exposed  too  soon.  It  is  true  that  the  sick  are 
cheered  by  the  sight  of  the  convalescent,  but  it  is  also  true  that  the 
very  sick  are  greatly  annoyed  by  the  ordinary  occupations  of  those 
who  are  nearly  well.  However,  there  is  space  enough  for  either 
method. 


262  Annual  Report  of  the  State  Board  of  Charities. 

It  may  be  said  that  it  will  be  impossible  to  beat  such  an  exten¬ 
sive  series  of  buildings  by  steam  in  such  a  cold  climate  as  we  have 
in  this  section  of  the  State.  All  experience  in  our  State  lunatic 
asylum  and  cotton  and  woolen  mills  goes  to  the  contrary,  and  with 
double  windows  it  is  proved  not  only  possible  but  easy. 

The  frontage  will  be  550  feet,  and  the  depth  225  feet. 

The  cottage  pavilions  at  each  end  will  contain  52  beds,  and  the 
four  open  wards  80  beds,  making  a  total  of  132  beds.  To  these 
may  be  added  21  more,  which  could  be  used  in  case  of  need,  in  the 
upper  rooms  in  the  front  of  each  pavilion,  making  a  total  of  156 
beds.  This  is  exclusive  of  those  in  the  rooms  in  the  main  build¬ 
ing,  and  in  the  servants’  quarters  in  the  rear. 

The  architect’s  estimate  of  the  cost  of  the  whole  structure,  includ¬ 
ing  steam  apparatus,  is  $75,000,  or  less  than  $500  per  bed.  This  is 
on  the  supposition  that  the  central  building  be  of  brick  and  the 
pavilions  of  wood.  Whether  these  estimates  are  correct  can  only 
be  ascertained  after  the  hospital  shall  have  been  completed,  and 
unfortunately,  the  trustees  have  not  yet  been  able  to  secure  the 
necessary  funds- — -which,  however,  they  hope  to  accomplish. 

Trusting  that  this  brief  contribution  to  the  subject  of  hospital 
construction  may  meet  with  your  approval,  and  thus  lead  to  the 
building  of  institutions  on  this  or  some  similar  plan ;  I  renjain 
with  great  respect, 

Your  obedient  servant, 

EDWIY  HUTCHmSOtf,  M.  D. 

Surg&bn-in-charge ,  St.  Elizabeth? s  Hospital. 
Utica,  N.  Y.,  January  1,  1875. 


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